Related Experiment Videos
Lipid tolerance in children receiving long-term parenteral nutrition: a biochemical and immunologic study
K A Dahlström1, O J Goulet, R L Roberts
1Department of Pediatrics, Huddinge University Hospital, Karolinska Institute, Stockholm, Sweden.
Insights
Intravenous lipid (intralipid) infusions can affect coagulation in children. Lowering intralipid doses during acute illness is recommended to prevent fat overload syndrome and monitor coagulation times.
Area of Science:
- Pediatric Nutrition
- Clinical Immunology
- Hematology
Background:
- Children on long-term total parenteral nutrition (TPN) often receive intravenous lipids.
- The impact of intralipid on immune function, complement, and coagulation requires further investigation.
Purpose of the Study:
- To prospectively evaluate the effects of intralipid on immunologic function, complement, and coagulation in pediatric TPN patients.
- To determine optimal intralipid dosing strategies, especially during acute illness.
Main Methods:
- Prospective study of 15 children receiving TPN for at least 3 years.
- Analysis of immunoglobulins, coagulation parameters (PT, PTT, platelets, fibrinogen), and complement components (C3, C4, CH100).
- Monocyte activation measured by chemiluminescence; fat tolerance assessed via serum triglycerides.
Main Results:
- Clinically stable children showed normal monocyte activation and complement levels.
- Prothrombin time (PT) and partial thromboplastin time (PTT) increased with intralipid dose but improved.
- Acutely ill children exhibited decreased fat tolerance, elevated triglycerides, and prolonged PT/PTT, with normal immune function.
Conclusions:
- Intralipid dosage should be reduced in acutely ill children to prevent fat overload.
- Close monitoring of PT, PTT, serum triglycerides, and cholesterol is crucial for safe intralipid administration.
Abstract:
The effect of intravenously administered lipids (intralipid) on immunologic function, complement, and coagulation was prospectively studied over 1 year in 15 children. The mean age of the children was 52.4 +/- 37.9 months; they had received total parenteral nutrition for an average of 3 years. Immunoglobulins (IgA, IgM, IgG), coagulation studies (platelets, prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen, fibrinogen degradation products, factor V) and components of complement (C3, C4, and CH100) were analyzed. Activation of monocytes by opsonized zymosan was measured by chemiluminescence and compared with that of normal control subjects. The clinically stable children had normal monocyte activation and normal complement levels. The PT and PTT values were significantly increased but improved with increased intralipid dose; other coagulation factors were normal. Acutely sick children, however, had decreased fat tolerance with significantly increased serum triglyceride levels and PT and PTT values; their monocyte activation and complement factors remained normal. These data indicate that the dose of intralipid should be lowered during acute illnesses; we suggest close monitoring of PT and PTT values and of serum triglyceride and cholesterol levels to avoid the fat overload syndrome.